WIN Notes
Spring 2000
Design of
Clinical Trial
Underway
Genes Play
Key Role in
Childhood
Obesity
Gorden
Continues
Distinguished
Research
Career
at NIH
Weight
Concerns
May Trigger
Smoking in
Youth
Conference
Highlights
Obesity as a
Public Health
Crisis
Girl
Power and
You! Begins
Phase II
Materials
From Other
Organizations
NIDDK
WIN Notes is
produced by the Weight-control Information Network (WIN). Questions or comments should be
referred to the editor, Weight-control Information Network,
1 Win Way, Bethesda, MD 20892-3665, phone (202) 828-1025, fax (202) 828-1028
The prevalence of overweight children and adolescents in the United States has doubled over the past 30 years. Today, one in four children and adolescents is overweight or at increased risk for becoming overweight.1 Some of our nation's schools have responded to this problem by implementing programs to help youths develop healthier habits and reduce obesity. Two successful approaches are demonstrated by "CATCH" and "Planet Health."
CATCH (Child and Adolescent Trial for Cardiovascular Health) is the largest school-based, health promotion, multisite randomized trial ever conducted in the United States. Funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, this multiphase study showed that healthy eating and physical activity behaviors taught to elementary school children were still being practiced 3 years later.
The initial study occurred between 1991 and 1994 in 96 elementary schools in 4 states: California, Louisiana, Minnesota, and Texas. It included students in grades 3, 4, and 5 who were from economically and culturally diverse populations. Nearly one-third of the 5,106 participants were African American or Hispanic. Health promotion efforts were aimed at increasing physical activity; encouraging eating foods low in total fat, saturated fat, and sodium; and discouraging smoking. These behaviors were taught through a multicomponent program that included classroom health lessons and activities, school environmental changes (such as serving school lunches lower in fat and modifying physical education activities), and family involvement and reinforcement.
In the followup study (1995-1998), researchers evaluated 73 percent of the program's original participants after they had moved on to middle school (grades 6, 7, and 8). Findings showed that the students who participated in the CATCH program in the earlier grades maintained a diet significantly lower in sodium and total and saturated fat, and continued to be more physically active than students in the control groups.
"We found that we could change school meals to reduce the amount of fat they contain and still serve food that children like to eat," said Guy S. Parcel, Ph.D., of the University of Texas Health Sciences Center in Houston and the lead investigator for the Texas CATCH study site. "What works best is to focus on foods that children already enjoy and learn to modify those foods."
The researchers note a narrowing difference between the CATCH intervention and control groups over time. "Although the effects of the behavioral intervention persisted over a long period of time, we found that the effects are beginning to fade," said Philip R. Nader, M.D., of the Division of Community Pediatrics at the University of California, San Diego, and the study's lead author and lead investigator for the California site. "This justifies continuation of school interventions over the middle and high school years."
Another successful school-based intervention is Planet Health, supported in part by the National Institute of Child Health and Human Development (NICHD) and the Centers for Disease Control and Prevention (CDC). Planet Health introduced health behavior messages to a group of 1,295 ethnically diverse sixth- and seventh-graders in public schools in four Massachusetts communities. Over the 2-year study period, the students received messages to eat less high-fat foods, eat more fruits and vegetables, increase physical activity, and decrease television viewing. The health promotion sessions were blended within the existing curriculum using classroom teachers and physical education teachers.
The Planet Health study, led by Steven L. Gortmaker, Ph.D., of the Department of Health and Social Behavior at the Harvard School of Public Health, assessed the prevalence, incidence, and remission of obesity of adolescents in five intervention and five control schools. At the end of the 2-year period, obesity had declined from 23.6 percent to 20.3 percent among the girls in the intervention schools; girls in the control group showed an increase of obesity from 21.5 percent to 23.7 percent. The boys showed no significant differences in weight. Both girls and boys in the intervention group had reduced their television viewing.
Dr. Gortmaker notes that the differing gender results related to weight could be attributed to the rapid growth in girls of this age and a heightened awareness of diet and activity issues. Planet Health or similar school-based interventions may be especially attractive to school administrators because these programs do not require additional classes and extra staff. "The success of this program implemented in public schools by regular classroom and physical education teachers indicates a promising approach to reducing obesity among youth," according to Dr. Gortmaker.
The Planet Health study is published in the April 1999 issue of Archives of Pediatrics and Adolescent Medicine. The CATCH study is published in the July 1999 issue of the same journal. Both study reports can be found on the Web at archpedi.ama-assn.org. CATCH program materials may be purchased from Flaghouse, Inc., 601 Flaghouse Dr., Hasbrouck Heights, NJ 07604; phone: 1-800-793-7900; Web: www.flaghouse.com.
1Troiano RP, Flegal MD. Overweight Children and Adolescents: Description, Epidemiology, and Demographics. Pediatrics. 1998;101:497-504. Overweight is defined here as the 95th percentile of body mass index (BMI). BMI values between the 85th and 95th percentiles are considered at increased risk for becoming overweight.
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